Courtney June Blomme, APRN, CPNP
Individual provider Active NPI Pediatric Nurse Practitioner · Marshall, MN
NPI 1326322975 · NPPES record last updated Mar 17, 2018
Key facts
- NPI
- 1326322975
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Nurse Practitioner 363LP0200X
- License
- CNP3713 (MN)
- Practice address
- 300 S Bruce St
Marshall, MN 56258-1934 - Phone
- (507) 537-9007
- Fax
- (507) 537-2720
- NPI assigned
- Sep 30, 2011
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151007001218 | MN | Practitioner - Nurse Practitioner | 6800104019 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Pediatric Nurse Practitioner, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CNP3713 | MN | MD | Pediatric Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Avera Marshall | Current | Accepting new patients | |
| Avera Marshall | Current |
Accepting new patients | |
| Avera Marshall | Current |
Accepting new patients | |
| Rural Health Care, Inc. | Past | Accepting new patients |
Locations
300 S Bruce St
Marshall, MN 56258
Phone (507) 532-9631
1521 Carlson St
Ste 100
Marshall, MN 56258
Phone (507) 476-4800
1325 S Cliff Ave
Sioux Falls, SD 57105
Phone (605) 322-5000
Interoperability endpoints
- courtney.blomme@avera.sdhealthlink.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | CNP3713 | MN | Yes |
Addresses
Primary practice location
300 S Bruce St
Marshall, MN 56258-1934
Mailing address
1025 Marsh St
Mankato, MN 56001-4752
Other practice location 1
1025 Marsh St
Mankato, MN 56001-4752
Phone (507) 625-4031
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CNP3713 | Other | MN | APRN LICENSE |
| R202004-6 | Other | MN | RN |
Other names
- Courtney St. Aubin
Other providers in Marshall, MN
- Hannah Bevers
- Mark Bigaouette
- Patrick Masiasia Birisi
- Nancy J Blanchard
- Christina Blomme
- Kristin R Blomme
- Martha Alicia Blomme
- Sonia Jo Bly
- Theresa Rose Bly
- Brian David Boersma
All providers in Marshall, MN · Pediatric Nurse Practitioner in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 17, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.